About the service: Hilton House is a nursing home that was providing personal and nursing care to 48 people at the time of the inspection.

People’s experience of using this service:

People felt safe and risks to their safety were managed. People received safe and effective care from staff who were well trained and supported to meet their needs.

People were supported by staff that were kind and compassionate who understood their preferences. People’ could make choices and were encouraged to be independent and their privacy and dignity was respected.

People were encouraged to take part in activities and were involved in the planning and review of their care.

People were involved in their care and gave their views about the service. Complaints were listened and responded to.

Systems to monitor the quality of care were effective, and picked up on any areas for improvement.

The registered manager encouraged a positive culture and learning was promoted within the service.

The service met the characteristics of Good in all areas;

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 4 January 2018).

Why we inspected: This was a scheduled inspection based on previous rating.

This inspection took place on 31 August 2017 and was unannounced.

The service was registered to provide accommodation and personal care for up to 55 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 52 people were using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in April 2016, the service was rated as ‘good’. At this inspection we found some breach of regulations. You can see what action we told the provider to take at the back of the full version of the report .

The risks to people were not always suitably assessed and managed. Staff knew people well but their risk assessments and care plans did not always contain enough up to date information to ensure they received consistently safe care.

Staff knew how to protect people from harm and abuse but the systems in place to ensure that allegations of abuse and harm were investigated were not always operated effectively. Suitable plans to reduce the risk of repeat incidents were not always put into place.

The principles of the Mental Capacity Act 2005 were not consistently followed to ensure that people’s rights were upheld.

Systems in place to monitor the quality and safety of the service were not always effective to ensure that issues were identified and acted upon to improve the quality and safety of the service.

There were enough staff to meet the needs of people who used the service and this was regularly reviewed by the registered manager and provider.

Medicines were safely managed, stored and administered to ensure that people got their medicines as prescribed. Staff were suitably trained and supported to meet people’s need.

People with provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks and enjoyed the food and drinks on offer.

People’s health was monitored and access to healthcare professionals was arranged when required.

People were treated with kindness and compassion and they were happy with the care they received. People were encouraged to make choices about their care and their privacy and dignity was respected.

People had support to meet their individual needs and preferences and were offered opportunities to participate in activities that interested them. People were supported to have care plans that reflected their preferences and staff knew people well.

People knew how to complain if they needed to. A complaints procedure was in place and complaints were dealt with in line with the procedure.

People, relatives and staff felt that the registered manager and providers were visible in the home and felt they were approachable. They promoted an open and inclusive culture where people and staff felt involved in the service.

This inspection took place on 26 April 2016 and was unannounced.

The service was registered to provide accommodation and personal care for up to 55 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 53 people were using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 27 January 2015, we asked the provider to take action to make improvements because they were not ensuring there were sufficient numbers of suitably qualified and experienced staff to meet people’s needs and were not providing care and treatment which met their needs. This action had been completed and improvements had been made.

There were enough staff to people’s needs. We saw that people's needs were responded to promptly and the registered manager regularly reviewed staffing levels to ensure they were suitable. Staff had undergone pre-employment checks to ensure they were suitable to work with the people who used the service.

People’s risks were assessed and managed to help keep them safe and we saw that care was delivered in line with agreed plans.

People felt safe and staff knew how to protect people from avoidable harm and abuse. Medicines were safely managed, stored and administered to ensure that people got their medicines as prescribed.

Staff were suitably trained to meet people’s needs and were supported and supervised in order to effectively deliver care to people. Staff understood how to support people to make decisions and when they were unable to do this, support was provided in line with current legislation and guidance.

People with provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks and were provided with support when required to ensure their nutritional needs were met. People’s health was monitored and access to healthcare professionals was arranged promptly when required.

People were treated with kindness and compassion and they were happy with the care they received. People were encouraged to make choices about their care and their privacy and dignity was respected.

People received person centred support from staff who knew them well. They were offered opportunities to participate in activities that interested them and could spend their time how they chose. Care plans contained information on life history and preferences so that staff had the information they needed to be able to provide support to meet people’s needs and requirements.

People knew how to complain and staff knew how to respond to complaints. A complaints procedure was in place and we saw that this was followed when complaints were received. People and their relatives were encouraged to give feedback on the care provided. The registered manager and provider responded to feedback and changes were made to improve the quality of the service provided.

The registered manager understood the conditions of registration with us. We saw that systems were in place to monitor quality and that the registered manager analysed information and took actions to make improvements when required. There was a positive atmosphere at the service and people felt the registered manager and providers were approachable and responsive.

We inspected this service on 27 January 2015. The inspection was unannounced. The service provides accommodation and personal care for up to 40 people. There were 34 people living in the home on the day of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in March 2014 we asked the provider to take action to make improvements relating to the management and assessment of risks to people, how they planned people’s care, medicines management and record keeping. Following this inspection we asked the provider to complete an action plan detailing when the improvements would be made. The provider completed the action plan and returned it to us within the timescale we requested. At this inspection we found that improvements were still required for the assessment and management of people’s risks. We also found the provider was not assessing people’s dependency levels accurately as there were insufficient staff to meet people’s needs promptly and there were no management arrangements in place to ensure their records accurately reflected changes to their care.

When people had been identified to be at risk of falls there were no referrals to specialist services to support people with a history of falls.

The management of medicines had improved. People told us they received their medicines as prescribed.

Staff received support from their manager. The staff were encouraged to access training to provide them with the skills they needed to provide care to people.

People were given the opportunity to consent to the care they received.

People told us staff supported them to maintain their independence. We observed that staff were kind, caring and compassionate. People received care which maintained their privacy and dignity.

People received care in the way they wanted because staff understood their preferences.

People were given the opportunity to spend their time as they preferred. There was support for people to take part in their hobbies and social events if they wanted to.

People were happy with the care they received but knew how to raise concerns if necessary.

We found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of this report.

This inspection was in response to information of concern received from relatives, other healthcare professionals and staff about the quality of care provided at the home.

On the day of the inspection, people who used the service told us they were happy with the care they received. We observed positive interaction between staff and people, but we saw that people’s care was not always delivered in a timely manner and in a way that kept them safe.

One person said, “I’m not here for long. I came from hospital because I wasn’t ready to go home. I’ve been fine and the staff have been lovely”. Relatives of people who used the service mostly told us that they were happy with the care provided. One relative said, “It’s just fantastic as in everything they do”. Another relative told us, “They’ve been very good”.

We found that people had plans in place with guidance about their needs and how they should be met, but care records did not contain up to date information, and people’s health needs had not always been monitored to ensure their plans of care were effective.

We found that people were at risk because the provider did not have effective systems in place for obtaining, recording, safe keeping, and disposal of medicines.

We saw the provider had appropriate numbers of staff with the right knowledge to deliver care to people.

We saw that people were at risk of unsafe or inappropriate care and treatment because the provider did not have always have appropriate records in place. We noted that some care records relating to people could not always be located promptly when required.